Why Depression and Sadness Are not the Same

Depression and sadness are often viewed as the same thing. Part of the confusion is that the most recognizable symptom of depression is sadness, according to Stephanie Smith, PsyD, a psychologist in practice in Erie, Colo.

Many people use the words interchangeably. “It’s just part of our popular culture. ‘I’m so depressed!’ to most of us actually means ‘I’m so sad!’ — except maybe it sounds a bit more sophisticated,” she said.

Sadness is a painful emotion. At times, it can feel utterly agonizing. But it’s “a normal response to difficult life events,” said Elaine Ducharme, Ph.D, a board certified clinical psychologist in private practice in Glastonbury, Conn.

When we think of depression as the same as sadness, we minimize the illness. We don’t realize the many other debilitating symptoms depression creates. We expect people to get over it quickly. But people with depression don’t. (In order to be diagnosed with depression, you must experience symptoms for at least two weeks.)

And when they don’t, we lose patience and run out of compassion. We blame the person for not snapping out of it, for not trying hard enough, for not being motivated enough.

When we conflate sadness with depression, we may think or say anything from “What do you have to be depressed about?” to “Happiness is a choice” to “But it’s all in your mind” to “Well, everyone gets depressed sometimes” to “Go out and get some fresh air… that always makes me feel better” to “You don’t like feeling that way? So, change it,” or any of these platitudes.

Sadness is actually a small part of depression, Smith said. Some people who have depression don’t even experience sadness, she said. Instead, they experience anhedonia, a loss of interest or pleasure in activities they previously enjoyed.

In order to be diagnosed with clinical depression, an individual must experience at least five out of nine specific symptoms, Ducharme said. (Again, this is for at least two weeks.)

Individuals may feel hopeless, helpless, worthless or guilty. They may experience a variety of cognitive symptoms, such as negative or distorted thinking, difficulty concentrating, forgetfulness, distractibility, memory loss, and indecision.

They may experience physical symptoms, such as extreme fatigue, headaches, stomachaches and muscle aches. They may sleep too much or too little. Their appetite may sink or rev up. They may feel as though the energy has been sapped out of them.

People with depression have described it as a black cloud following them everywhere they go. Some people describe feeling numb or empty. Some are utterly exhausted, so much so that getting out of bed is hard and walking to the mailbox feels like a workout.

“Things around them may appear grey rather than their true colors,” Ducharme said. Instead of feeling fueled and energized by their relationships, professions or life in general, they feel depleted and find it difficult to enjoy anything, she said.

Men may seem angry, act aggressively, and quickly lose their temper, she said. They “may try to deal with life with excess alcohol, which often just fuels their anger.” (“But, when truly assessed it can become clear that they are avoiding feelings,” she said.)

Postpartum depression also commonly gets dismissed as “just the baby blues,” Ducharme said. However, it’s a real and treatable illness, though it is undertreated, she said. In this piece, advocate Katharine Stone noted that some research has even found that only 15 percent of women with postpartum depression ever get professional help.

Depression also goes untreated in individuals who undergo cardiac procedures, even though they have a high rate of depression after surgery, Ducharme said. “They often are facing their own mortality in a way they probably never did before,” and may have a difficult time “re-engaging in life.”

Again, sadness and depression are not the same thing. One is a normal response to tough times; the other is a serious (and treatable) illness.